BackgroundA number of case-control studies were conducted to investigate the association of common type 2 diabetes (T2D) risk gene polymorphisms with gestational diabetes mellitus (GDM). However, these studies have yielded contradictory results. We therefore performed a meta-analysis to derive a more precise estimation of the association between these polymorphisms and GDM, hence achieve a better understanding to the relationship between T2D and GDM.MethodsPubMed, EMBASE, ISI web of science and the Chinese National Knowledge Infrastructure databases were systematically searched to identify relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to examine the association between 9 polymorphisms from 8 genes and susceptibility to GDM. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Heterogeneity among articles and their publication bias were also tested.ResultsWe identified 22 eligible studies including a total of 10,336 GDM cases and 17,445 controls. We found 8 genetic polymorphisms were significantly associated with GDM in a random-effects meta-analysis. These polymorphisms were in or near the following genes: TCF7L2 (rs7903146), MTNR1B (rs10830963), IGF2BP2 (rs4402960), KCNJ11 (rs5219), CDKAL1 (rs7754840), KCNQ1 (rs2237892 and rs2237895) and GCK (rs4607517); while no association was found for PPARG with GDM risk. Similar results were also observed under dominant genetic model for these polymorphisms.ConclusionsThis meta-analysis found 8 genetic variants associated with GDM. The relative contribution and relevance of the identified genes in the pathogenesis of GDM should be the focus of future studies.

What is known and objective: Metformin has been suggested to confer anticancer efficacy. However, it remains uncertain whether additional use of metformin could improve survival of women with breast cancer. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the influence of metformin on survival outcome in women with breast cancer.

Objectives To evaluate the long-term effects of bare-metal stent (BMS) implantation in patients with coronary artery stenosis or occlusion lesions and with symptoms of angina pectoris. Methods 224 patients with serious stenosis (75% to 100%) of a native coronary artery presenting with symptoms of angina pectoris were enrolled from1 Mach, 2001 to 1 Mach, 2010. Among them there were 123 cases with hypertension (54.9%), 52 cases with diabetes mellitus (23.2%), 3 cases (1.3%) with old myocardial infarction and 32 cases (14.3%) with hyperlipidemia. 74 patients (33.0%) were smoker. The coronary angiography showed that the type 1 lesion characteristics were 95 cases (42.4%), type 2a lesion characteristics were 50 cases (22.3%), type 2b lesion characteristics were 46 cases (20.5%) and type 3 lesion characteristics were 33 cases (14.7%). Single coronary vessel lesion was 143 cases (63.8%), double coronary vessel lesions were 64 cases (28.6%) and three coronary vessel lesions were 17 (7.6%). BMS was implanted in the ischemia related coronary lesion. The diameter of the implanted stents was (3.16 ± 0.42) mm with length of (18.38 ± 6.15) mm. After the procedure of PCI recommended antiplatelet regimen included clopidogrel and aspirin for 2 months and followed by chronic aspirin therapy. All patients were followed for 24 to 157 months with an average of (93.50 ± 39.20) months. The main endpoint of follow-up was the occurrence of the first major adverse cardiac event (MACE), defined as death due to all cause, nonfatal recurrent myocardial infarction, and target lesion revascularisation (TLR) and target vessel revascularisation (TVR), heart failure with III class and over, very late thrombosis in stent and stroke. Results Complete clinical status was available in 224 patients to the end of follow-up. The combined cumulative MACE rate was 37.5% (84 cases) with an average of 4.81% per year. The number of death due to all cause was 32 cases (14.29%) with an average of 1.83% per year. The rate of TLR was 14.29% (32 cases) with an average of 1.83% per year. The rate of TVR was 6.25% (14 cases) with an average of 0.80% per year. The rate of heart failure with III class was 1.33% (3 cases). CABG was need in 2 cases (0.89%). The very late thrombosis in stent (1 case, 0.45%) presenting STEMI was very low. 2 case (0.89%) died to cerebral haemorrhage occurring within 24 month after the PCI. Conclusions It was the low incidence rate of MACE in the long-term follow-up for more than 2 years that BMS was used to treat unselective coronary artery stenosis lesions.

Objective To determine and analyse the success rate and key operational points of a new technique of opening the coronary chronic total occlusion (CTO) lesions: Crow Bar Effect. Methods and procedure of crowbar effect technique 48 patients with coronary CTO lesions receiving interventional approaches through the crow bar effect (Crow Bar Group) and 72 patients with CTO receiving classical ante-grade guide wire technique (Control Group) were investigated from February 2007 to December 2012. All patients in groups suffered from unstable angina pectoris with the grade 2–4 level lasting for six months and over. There was no statistically significant difference in the distribution of gender, age and duration of vascular occlusion between groups (p > 0.05). No-hydrophilic-coated and moderately stiff guide wire was firstly used to puncture fibre cap of proximal segment of CTO lesions into distal vessel under the supporting with micro-catheter or small balloon, and was confirmed by multi-angle CAG judgment into the true lumen. When the balloon was pushed to be unable to get in the lesions, the second guide wire (with hydrophilic coating) along the first thread trace was pushed through the lesions to distal vessel. As following the third guide wire (super stiff guide wire with hydrophobic-coated was usually selected) was inserted into lesions to distal vessel.Then, small balloon (diameter 1.25 mm) was pushed along a guide wire into the lesions. When the small balloon was not still pushed to insert the lesions, small balloon under keeping certain push force condition was repeatedly dilated with high pressure (12–16 atm). After high pressure expansion of balloon at every time the balloon was able to make forward 2–3 mm, and slowly passed through the lesions to distal vessel so repeatedly. After the over procedure a softer guide wire was retained in the vessel, per-dilatation was completed with larger balloon (routinely 2.0 × 20 mm balloon), and then DES was implanted. This expansion force of small balloon with high pressure repeatedly push another two guide wires on both sides to pry dense fibro-plaque tissue of coronary occlusion lesions and to make the channel which small balloon can enter into. This role is called crowbar effect technique. Results The success rate of PCI procedure was 89.6% in Crow Bar Group and 73.6% in Control Group and difference in the success rate is statistically significant (P < 0.05). The occurrence rate of the complication was 8.3% in Crow Bar Group and 5.6% in Control Group, and the difference in the complication between groups was not statistically significant (P > 0.05). Coronary artery perforation was the major complication which was mostly caused by the puncture of the guide wire into external wall of the vessel, but there was no serious consequence. Conclusion The new technique of crow bar effect is an effective and simple approach to open CTO lesions with a high success rate. When the balloon can't pass through CTO lesions, this method may be used to increase the success rate of op...